-Leena Augimeri, Ph.D. (et. al.)
Published in 2001, 94 pages
Early Assessment Risk List for Girls (EARL-21G) Version 1, Consultation Edition
What is the EARL-21G? The EARL-21G is a structured clinical risk assessment device that provides a comprehensive framework to evaluate 21 risk factors known to influence young girls’ propensity to engage in future antisocial behavior. The device is research-based and informed by the clinical expertise of people with extensive experience treating girls under the age of 12 with conduct problems.
What is the structure or format of the EARL-21G? The device contains 21 Items that are organized under three broad sections: Child, Family, and Responsivity. Each Item is rated on a 3-point scale (0-not present, 1-possibly present, 2-present) where a higher score represents greater risk. All factors are weighted equally to yield a total maximum score of 42. In addition to the rating column, there is also a “critical risk” column that allows clinicians to red flag factors that are particularly concerning, and an “overall clinical judgment” rating that allows assessors to assign an overall, global rating of risk.
How much time does the EARL-21G take to administer The answer to this question depends on the amount of information one has prior to conducting an EARL-21G assessment. We encourage users of the device to gather as much information as possible that is relevant to the child’s antisocial behavior. Information from case conferences, child and parent interviews, psychological reports, school assessments, and standardized clinical measures should be considered. Once this is done, an assessment can be typically performed in about 15 to 30 minutes.
Are there separate coding forms, protocols, or other materials that I need to purchase to use the EARL-21G? No. We designed the device to be “self contained” so that users need only to read and understand the manual to begin performing EARL-21G assessments. A one-page blank coding form (“summary sheet”) is included in an appendix for unlimited photocopying. While not required, we do encourage users of the device to attend EARL-21G training in addition to joining a registry maintained by the authors. Information about both is contained in the manual.
Are there cutoff scores? No. We warn against the use of cutoff scores in making mechanical decisions about a child’s risk potential or with respect to treatment resource allocation. The inclusion of the “critical risk” column on the summary sheet reflects the notion that a single present factor can represent high risk and for this reason the pattern of risk variables, rather than a total score, should be assessed when making statements about risk potential.
With what population is the EARL-21G to be used? The device was developed for girls, under the age of 12, who are thought to be at risk for future antisocial behavior. The items were developed through an exhaustive search of the child psychopathology literature on children under the age of 12, with a specific focus on factors that have been linked to future aggression and antisocial behaviour. Although conceptually applicable to very young children (i.e., those 0-6 years), for the most part, the EARL-21G has been applied to clinical populations of children aged 6-11. Devices for adolescents (e.g., SAVRY) and adults (e.g., HCR-20) are available for older subject populations.
Can the EARL-21G be used with males? No. Realizing that the same risk factors may be expressed differently, and that other risk factors may play an important role in the etiology of aggression and antisocial behavior, we developed a separate, but parallel risk assessment device for boys: the Early Assessment Risk List for Boys (EARL-20B). While the EARL-20B shares a number of common Item headings with the EARL-21G, it includes a specific review of the male child psychopathology literature, and the Item contents have been tailored to reflect differences between girls and boys in the manifestation of risk at an early age.
Can the EARL-21G help with intervention planning as well as with risk management? Yes. In fact, we argue that persons who use the EARL-21G to identify risk have an ethical obligation to do something about it. This is one of the benefits of using a structured clinical risk assessment device such as the EARL-21G. We view each Item or risk factor as a “starting point” from where additional assessment, and ultimately, risk management can begin. The EARL-21G assessment can greatly assist in the formulation of treatment plans and goal setting with parents. Although it is more common for the device to be used by a single clinician or clinical team, we have used the device with parents to compare clinician and parent Item scores for the purpose of reviewing discrepant perceptions and addressing areas of clinical concern. This provides families with a participatory role in the clinical process, in addition to helping them gain a better understanding of risk and risk factors.
Who is qualified to use the EARL-21G? We state up front in the EARL-21G manual that the scheme is to be used only by professionals experienced in the field of childhood aggression.” With the requisite experience, the manual can be used successfully across a variety of domains and disciplines including children’s mental health, child protection, medicine, education, law enforcement, community health, psychiatry, psychology and social work. Although not required, training from the authors is encouraged above and beyond a full reading and understanding of the EARL-21G manual.
Has any research been conducted on the EARL-21G? Yes. To date, two studies have been completed on the EARL-21G, Version 1 (for more details, see www.earlscourt.on.ca). The device has been found to be easy to use, clinically useful, and a reliable and valid predictor of future antisocial behavior. For example, the manual describes results from a retrospective file study of 67 girls that compared EARL-21G Version 1 scores at discharge from a children’s mental health program with subsequent youth and adult criminal convictions, on average 7 years later. Children with above-median EARL-21G scores were more likely to be found guilty than their lower-scoring counterparts, although this difference did not reach statistical significance. Statistically significant inter-rater agreement was also obtained on a sample of 30 cases, demonstrating the device’s reliability. A subsequent prospective study replicated these findings, yielding intra-class correlation coefficients ranging from .80 to .96.
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